Tune Up: Are Cleanses the Cure?

Once dismissed as a weight loss fad, detox therapy may actually have health benefits

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The quest to achieve purity by removing bad things from the body goes back at least to ancient hatha yoga practices and Indian yogis swallowing cloth strips in order to pull filth out of their digestive systems. These days, we're more likely to be fixated by fanciful stories of celebrities "detoxing," the non-drug and alcohol version, that is—those Hollywood starlets who do weekly high colonics instead of lunch. "Tom puts Katie on an Extreme Detox," informs the March 23 cover of Life & Style Weekly. Or Beyoncé admitting on Ellen that to lose 20 pounds for Dreamgirls, she went on the Master Cleanse (water, lemon juice, cayenne pepper, and a dash of maple syrup; no food) and that it made her "evil."

None of this will convince you that you might want to investigate this stuff beyond gawking at it in the tabloids. However, in the past year, three prominent integrative medicine MDs have each published persuasive-sounding manifestos that cover, wholly or in part, the practice of detox. There is Woodson Merrell (The Source: Unleash Your Natural Energy, Power Up Your Health, and Feel 10 Years Younger), who is chairman of the department of integrative medicine at Beth Israel Medical Center; Frank Lipman (Spent: End Exhaustion and Feel Great Again), an engaging South African who runs his own wellness clinic, Eleven Eleven, in Manhattan's Flatiron District; and the new kid on the block, Lenox Hill Hospital– affiliated cardiologist Alejandro Junger, whose Clean: A Revolutionary Program to Restore the Body's Natural Ability to Heal Itself just hit bookstores.

Of course, this being New York, fashion and fabulousness don't trail far behind. On her closely watched website, GOOP, Gwyneth Paltrow reported that she was pleased to have found Junger, who suggested to her a more sensible program, "a good detox that is not as hallucinogenic (in a bad way) as the Master Cleanse." Paltrow's buddy, fashion icon Donna Karan, is another walking advertisement for the detoxified life. (She, like Gwynnie, does look pretty amazing these days.) Her Urban Zen Integrative Therapy program brings alternative therapies to some of the sickest patients at Beth Israel, and she's personally managed the neat trick of being a patient, friend, and pro bono PR maven for the three book-writing doctors.

"I couldn't live without any of them," Karan tells me over the phone, on break between yoga sessions at her vacation home in Turks and Caicos. "Juices, raw soup, and salads are a way of life for me. When I would talk about this years ago, people would look at me like I was crazy. But today, the awareness and the desire are there."

Yes, they are. But if you don't have the time or interest (or money) to treat your body like the Manhattan Project, the question remains: How seriously to take all this? Mainstream medicine has its answer: not very. Talk to your gastroenterologist and odds are you'll get some version of The Lecture: Homeostatis 101. The body has its own precise mechanisms to maintain physiological balance—pH and fluid levels in the blood, for instance—that are lot smarter than you. If you try to force the body into some unnatural extreme state with fasting or colonics, you're being silly at best and at worst risking real damage from dehydration and screwing up your sodium and potassium electrolyte levels. (The dangers could be grave with a DIY approach, especially if you have an underlying medical issue.)

The mainstream media mostly follows suit. In the past year, Time scolded, "Detox, Shmeetox"; The New York Times warned, "Flush Those Toxins! Eh, Not so Fast"; and the Harvard Women's Health Watch ran a feature on "the dubious practice of detox." When it comes to the "detox in a box" type products found in health food stores, some containing powerful laxatives, or the fringy stuff available on the Net, such as the detox foot pads that allegedly suck the bad stuff out of your feet, then it's truly shooting-fish-in-a-barrel time.

What the mainstream doesn't factor into this dismissal is the recent peer-reviewed research that documents actual health benefits from limiting calorie intake ("caloric restriction") or fasting and the ability of low-fat, veggie-heavy diets to reduce the symptoms of common chronic diseases. A movement that was fueled in part by a rebellion against the soullessness of Western high-tech medicine now feels it has science on its side, as well as the premier interpreter of that science. That would be a one-time colleague of double Nobel Prize winner turned maverick nutritional scientist Linus Pauling, with the unlikely-to-inspire name of Jeffrey Bland.

In February, at the Integrative Healthcare Symposium held at the Hilton New York Hotel, Bland permitted himself a throw-down moment against the hegemony of the medical establishment and Big Pharma. "The days of apology are over," the former chemistry professor told a packed conference room. "In fact, the days of being polite are over. We have a country that's being brought to its knees by the burden of chronic disease."

With the Oprah show practically a holistic-health house organ these days, heart surgeon Mehmet Oz, MD, has joined cardiologist Dean Ornish, MD, and medicinal herb-loving Andrew Weil, MD, in the alternative-doc brand name department.

By contrast, Bland, 64, as genial and ruddy-faced as a favorite great uncle at Christmas, is the guru who nobody outside the alt-med world knows. Merrell calls him "a national treasure"; Lipman describes him as "the most significant person in changing medicine." At the conference, one much-published alt-med savant recalled first hearing Bland speak 15 years ago: "I said, `Either this man is insane or he's a genius, and I owe it to myself and my patients to find out which.' "

They love Bland for bringing intellectual clarity to a field that, aside from borrowed Chinese health concepts like "balance" and "energy," often lacked a coherent rationale for what it was doing. A PhD, not an MD, he cofounded the Institute for Functional Medicine in Washington State. In the Functional Medicine view, the thousands of diseases in the medical texts are just late-in-the-game manifestations of a number of basic metabolic processes that have gone awry—inflammation, for instance. (The way these mechanisms play out in the body is unique to the individual.) Food isn't just fuel to run the human machine. The chemical compounds that make up what we eat provide a constant flow of instructions to your genes—make more of this protein, less of that one—that in their totality help determine whether our bodies are healthy or sick. For instance, the omega-3 fatty acids in fish quiet down inflammation at the cell level, arachidonic acid in red meat fires it up. (Speaking for the open-minded mainstream, Donald Hensrud, MD, chair of the preventive and occupational-medicine departments at the Mayo Clinic, describes this "epigenetic" view of nutrition as "plausible, but in its infancy, and the details need to be worked out.")

Stripped of its lofty biochemistry, Bland's take-home message is not so different from what you might get from your grandmother (up with fruits and vegetables) or at the corner health-food store (down with meat, dairy, and wheat/gluten). But Bland has helped integrative docs codify detox regimens that they believe can tip the balance toward health for the legions of patients who come to them with symptoms that conventional medicine routinely shrugs off as vague and nonspecific, such as fatigue, irritable bowel, headaches, rashes, joint pain, and enervating hormonal ups and downs.

The theory, briefly put, is this: The body is constantly dealing with foreign chemicals that it takes in (ingests, breathes, absorbs) from the outside world in a two-step process. In phase 1, liver enzymes break down the chemicals into compounds that are often more dangerous than the original stuff—in the process, creating free radicals that cause "oxidative damage" in the cells (or "rust"). In phase 2, the liver neutralizes these compounds with the help of other nutrients, including key amino acids made from the protein we eat, and the waste is excreted.

These pathways were worked out 30 years ago by researchers studying how the body breaks down pharmaceutical drugs. But Bland expanded the concept. He theorized that the body's age-old detoxification system was under assault from modern industrial chemicals, especially pollutants linked to disease—car exhaust and cigarette smoke in the air, mercury and PCBs in fish, and the compound Bisphenol A used to manufacture plastic bottles—many of which lodge in our fat cells for years. One theoretical justification for fasting is that it removes the bad stuff from fat-cell storage, thereby liberating it to enter the bloodstream, where it can be processed by the liver and made water-soluble, then dumped. But here's the catch: If the body doesn't take in the necessary nutrients during a water fast, for instance, the liver doesn't get the nutritional support it requires to neutralize (phase 2) all those free radicals produced in phase 1, which can wind up making you feel worse.

"We used to see it all the time in medical spas before we understood what was going on," Bland says. "In emergency rooms, you often see elderly people and alcoholics being admitted for acetaminophen [Tylenol] overdoses. They don't have the necessary nutrition to process what would otherwise be nontoxic amounts of the drug."

Bland's work has helped the alt-med clinicians arrive at a rough consensus about the safety and usefulness of many practices on the detox menu. A water fast can be unnecessarily dangerous. The Master Cleanse is borderline, lacking adequate nutrition for liver support and good health. But a juice fast of limited duration, say two or three days, with guidance from a physician, is a middle-of-the-road winner. While conventional medicine has nothing against saunas, so long as you avoid dehydration and overheating, holistic types see them as a vehicle to remove toxins from the sweat and oil glands. They can point to a real, if skimpy, research literature to back that up. The sauna has been used to treat medical conditions like rheumatoid arthritis, but it involves long cooking times and a doctor's supervision. A 15-minute shvitz is more akin to a good exercise sweat: The health benefits, while possibly real, are not easy to pin down.

After that, the alt-med road map gets hard to follow. There is, for instance, precious little established science to justify the practice of colonics, since most of the detoxification of chemicals in the gut occurs in the small intestine, not the colon, where the water actually reaches. (Of the three book-writing doctors, only Junger regards colonics as a routine part of a "cleansing" regimen. Mainstream docs are mostly alarmed at the possibility of infection.)

But there are more fundamental questions to consider. Are we really being poisoned by the witches' brew of 148 man-made chemicals that, according to the Centers for Disease Control, percolate in the average American's body, even though obvious cases of chemical poisoning do not routinely turn up in the emergency room? Could this more subtle form of toxicity be linked to the mysterious rise of certain diseases such as chronic fatigue and fibromyalgia?

In their books, Merrell, Lipman, and Junger lament like a Greek chorus about the degraded state of our outer and inner environments. They could be right, but the connection between "subclinical" levels of pollutants and chronic disease is still mostly theoretical. Columbia University's Michael D. Gershon, MD, a world authority on the gut, can follow Bland's logic that fasting could hypothetically speed up the liver's phase-2 detox of industrial chemicals, but wonders why you'd risk putting the body "in a deficit state" for such a nebulous payoff. "Let's face it, how many of us are carrying around toxic levels of dioxin?" he says. "If you happen to be scuba diving in the sludge at the bottom of the Hudson River, well, okay."

And can we really trust Jeff Bland the researcher to frame the problem of toxicity when he's also the chief science officer and a principal owner of a company that's in the business of supplying part of the solution? Metagenics, which reaped about $200 million in wholesale revenue last year, sells nutritional formulas aimed at metabolic problems such as a sluggish thyroid or a cranky digestive system, as well as supplement powders for shakes that can be combined with juices and whole foods for individually tailored "cleanse" regimens. (Bottles and tubs, mostly in the $30 to $50 range, are sold by health care providers, not at your local Vitamin Shoppe.)

In a standard cleanse, for 21 days or so you abstemiously limit the bad things going in and maximize the good. Typically, gluten, dairy, beef, pork, alcohol, coffee, soft drinks, and sugar are verboten. (It's a given in the alt world that gluten and dairy trigger "food sensitivities." Conventional medicine says that if these were true allergic responses, they would show up immediately, powerfully, and on the standard diagnostic blood test. That alt-med animus against coffee and routine amounts of sugar as up-enders of metabolic and adrenal balance elicits mostly yawns from the mainstream.) You might, for instance, combine one light meal with two shakes fortified with a "medical food" like Metagenics UltraClear powder that contain immune system-friendly rice protein and micro-ingredients derived from green tea, broccoli, watercress, and pomegranate juice that the company claims to be phase 1 and 2 detoxification winners. (Your morning OJ, healthy if acidic, doesn't make this detox cut, and grapefruit juice actually interferes with phase 1 detox, which is why you're not supposed to drink it on antibiotics.) Whether they have anything to do with industrial chemicals or not, the results, say Lipman and Junger, cover the range of what ails you: more energy, clearer skin, less bother from headaches and hormones—you name it.

The reliance on supplements does pose an awkward philosophical question: Can Mother Nature really be improved upon in the lab? Merrell says his emphasis is on healthy day-to-day living, supplements often not needed. (All three books are chockablock with recipes for things such as breakfast smoothies made from almond or rice milk, fruit, and flax.) Lipman and Junger see Metagenics-type products, used as a daily supplement or as part of a cleanse, as a practical tool to counter patients' often busy schedules and nutritional cluelessness.

For his part, Bland says the idea behind his products is not to build up a "dependency on powders," but to "get patients over the hump" toward healthy whole-food eating. The feds have had their suspicions. In the late '80s and early '90s, Bland had his wrist slapped by the Federal Trade Commission twice—for an improper doctor testimonial and also for an objectionable televised claim. As recently as four years ago, the FDA was looking into possibly overreaching health claims. (The FTC grievances were settled, while the FDA chose not to investigate further.) But his stock in Washington seems to have risen since then. Two weeks after the Manhattan conference, he was off to DC with a group including Drs. Oz, Ornish, and Weil to lecture a Senate subcommittee on how to control spiraling health care costs by focusing on lifestyle and preventive health rather than expensive and, yes, even potentially toxic, pharmaceuticals to treat serious disease after the horse is well out of the barn.

If Jeffrey Bland is its egghead-in-residence, Alejandro Junger, a hypercharismatic Uruguayan, is poised to become the detox movement's It Boy, assuming Clean can break through the health-book clutter. ("Between Spent and Clean, I think that really says it all," Donna Karan says. "I'm spent and I need to be cleaned!") Of the three Friends of Donna, Junger, 45, is the most radical and, paradoxically, the only one who operates within a high-tech medical subspecialty, one day a week at Lenox Hill Hospital as a cardiologist plus the time he puts in at Lipman's Eleven Eleven Wellness Center as an integrative physician. ("He's like my naughty younger brother," Lipman says.) It's a neat straddle that Junger has arrived at only after considerable struggle, after his residency at NYU Downtown and his fellowship at Lenox Hill in the '90s left him a basket case.

"I was working like a maniac, being on-call days in a row, and eating from cafeterias," he tells me, stealing a break from a treadmill stress test he's administering. "I started experiencing problems: weight gain and allergies, then all sorts of problems digesting. I was diagnosed with irritable bowel syndrome. My mind also led to feelings of depression and a psychiatrist wanted to put me on an SSRI antidepressant, but I refused.... I was given seven prescription medications in all. But it wasn't until I did my first cleanse and detox that I was completely cured. Not cured. I'm sure if I go back to eating crap, I'm gonna have the same result. So I'll say, the dysfunction corrected."

Junger then studied meditation in India and served as the medical director of the We Care Spa near Palm Springs, which specializes, controver-
sially, in juice fasts and colonics. Today he sounds amazed, if stressed, to be back in Manhattan, shuttling between two different medical cultures. He gives mainstream medicine its due: "My sister had a kidney transplant; there was no meditation or herb that would have cured that." And just like every other holistic philosopher, including Bland, he cautions that detox treatments are not "magic bullets," but one part of a rebalancing of mind, body, and spirit (which can only sound trite in print). But Junger goes further out than other doctors I've talked to extolling the restorative power of a low-calorie/high-nutrient cleanse. "Fifty percent of the people who cleanse who have mild to moderate diseases, they come back and say they don't have anything," he says. "And then the other 40 to 50 percent, maybe there's something structurally broken that you have to really take care of. So maybe you do a combination of things."

Stephen Barrett, MD, a retired psychiatrist turned influential "quackbuster" (quackwatch.org), sees himself as a beleaguered guardian of scientific dispassion and objectivity. He'll concede only this: "Fasting with juice is less dangerous than water, but neither has any value. The only thing I would say about a medically supervised juice fast is that there are very few doctors who do it and all of them should lose their licenses." Barrett on Bland is only a hair more charitable: "He offers up one biochemical tidbit after another. It's like he's got a shotgun, and every once in a while he might hit something significant, but that's not who I want to get my information from."

Bland's admirers admit he's more of a big-picture visionary than someone who does the sort of outcome studies likely to dent mainstream consciousness. (Even Barrett says he's modified his diet in light of Ornish's work that showed a low-fat diet could help reverse the blockage of coronary arteries.) But reality seems to be catching up with Bland's futuristic speculation. The past few years have seen studies suggesting that the same low-fat, high-fruit-and-veggie diet with exercise and yoga could slow, stop, or even reverse the spread of early-stage prostate cancer (Ornish again, in The Journal of Urology) and that consuming broccoli and other cruciferous vegetables may protect against respiratory inflammation that causes conditions such as asthma (a UCLA team publishing in Clinical Immunology).

Directly on point when considering the merits of a juice cleanse is research that has shown fasting to improve health. From the '70s to the '90s, Scandinavian researchers published a raft of studies showing that juice fasts followed by a vegetarian diet could reduce the symptoms of rheumatoid arthritis for up to a year. And the National Institute on Aging has funded research that suggests a more efficient insulin response in humans who fasted every other day. (With age, the body usually has to secrete more insulin to clear sugar from the blood, one of the key drivers of human aging.)

I ask Eric Ravussin, PhD, a lab director at the Pennington Biomedical Research Center in Baton Rouge who authored some of these studies, whether it was plausible that a less radical form of fasting—a two- or three-day juice fast every month or season—might confer some long-term health benefits. "Abso­lutely," he said. "One theory is that a little bit of stress is good for the cells." The anthropologically minded speculate that it's a genetic inheritance from our hunter-gatherer ancestors whose metabolisms had to adapt to periods of privation. The Friends of Donna believe that taking a digestive "vacation" frees up energy to repair the metabolic system. (And, while nobody likes to say "diet" anymore, it's hardly a secret that cleanses are a handy way to lose weight.) The molecular biologists are hot on the trail of so-called longevity genes, sirtuins, acted on by caloric restriction and, famously, by resveratrol, a compound found in red wine and certain fruits.

Ravussin points out that it's a big leap from intriguing preliminary research to the government sending out a public health alert recommending that we all go on juice fasts. But I don't think mainstream medicine is doing us any favors when it fails to make any real distinction between detox practices like juice fasts or supplement-shake cleanses that have a plausible scientific rationale and the fringy stuff that is plainly pseudoscience. I should know. I visited a Manhattan spa for a detoxifying foot bath treatment ($70 for 30 minutes); you flip a switch and watch in alarm as the water turns dark and gunky, which, even the manufacturer admitted to me, has more to do with the chemical reaction between the metal electrodes and the mildly charged salt water than toxins fleeing my body.

I ask Bland if this sort of stuff bothers him. "I guess I'd ask the question, Did you feel better at the end? " he says. (Well, my feet did have a mildly pleasant buzz.) "And when you're relaxed and your cortisol levels are lower and you've got better signaling molecules and you've lowered your inflammatory mediators, doesn't that then set up a different symphonic orchestration of your detoxification machinery?" Wow. According to this blinded-by-science reasoning, alternative detox therapies can't lose (unless they're actually harmful). Either they work because they really work or because they make you feel good. But it was Bland and the Manhattan integrative doctors, backed up by the latest nutritional research, who convinced me that we can dispense with magical detox thinking. Food is real magic. And, from time to time, maybe not eating much of it can be, too.